压力支持通气在婴儿及早产儿眼科手术中的应用效果

Efficacy of pressure support ventilation general anesthesia in infants and premature patients undergoing ophthalmologic surgeries

目的 探讨喉罩全麻压力支持通气（PSV）方案在不同周龄婴儿（含早产儿）眼科手术中应用的安全性和可行性.方法 选取2014年11月至2015年7月北京大学人民医院拟行全麻下眼底手术的患儿42例,矫正胎龄（末次月经至接受手术时的周数）38～92周,按矫正胎龄分为3组：矫正胎龄≤44周（A组）,44周＜矫正胎龄≤64周（B组）,64周＜矫正胎龄≤92周（C组）.面罩吸入6％七氟烷诱导,保留自主呼吸.置入喉罩后,据临床情况调整七氟烷维持浓度及通气参数,球后神经阻滞后开始手术,术中全程保留患儿自主呼吸.记录手术开始前（T0）、开始15 min后（T1）、开始30 min后（T2）的呼气末七氟烷浓度、循环及呼吸参数,记录停七氟烷至喉罩移除时间、术中及术毕不良事件.结果 42例患儿完成试验并纳入分析,A组10例,B组17例,C组15例.3组患儿术中血流动力学稳定,停七氟烷至喉罩移除时间差异均无统计学意义（均P ＞0.05）;组内各时间点的呼气末七氟烷浓度、单位体重分钟通气量、呼气末二氧化碳、肺顺应性差异均无统计学意义（均P ＞0.05）;B组及C组的T1点呼吸频率分别为（33.1±5.7）、（29.4±6.4）次/min,T0点分别为（35.8±7.4）、（32.1±5.6）次/min,差异有统计学意义（F=5.087、5.628,P＜0.05）;B组及C组的T1点气道峰压分别为（14.5±3.1）、（14.3±2.2）cmH2O,T0点分别为（14.1±2.9）、（13.1±1.5）cmH2O,差异有统计学意义（F =4.923、12.393,P＜0.05）;呼气末七氟烷浓度、呼气末二氧化碳、单位体重呼出潮气量、呼吸频率、单位体重分钟通气量、气道峰压组间比较差异均无统计学意义（均P＞0.05）.3组均无严重不良事件发生.结论 基于PSV通气的全麻管理方案,可有效保留喉罩通气婴儿（含早产儿）的自主呼吸,可以作为此类患儿眼科手术的麻醉选择.

Objective To investigate the efficacy of pressure support ventilation （PSV） general anesthesia in infants and premature patients undergoing ophthalmologic surgeries.Methods A total of fortytwo infants undergoing vitreoretinal surgeries in Peking university people＇s hospital from Dec.2014 to Jul.2015 were enrolled in the study,whose post-conceptual age （PCA,duration from the mother＇s last menstrual period to the date surgery was performed） were 38-92 weeks.They were divided into 3 groups according to PCA,which were group A （PCA≤≤44 weeks）,group B （44 weeks 〈 PCA ≤64 weeks） and group C （64 weeks 〈 PCA≤92 weeks）.Anesthesia was induced with 6% sevoflurane inhalation by mask.After placement of laryngeal mask airway,patients were breathing spontaneously during the whole procedure with the inhalational maintenance concentration of sevoflurane and ventilation parameters adjusted according to clinical set.The surgical procedure begun when satisfying retrobulbar nerve block was achieved.The endtidal concentration-of sevoflurane,hemodynamic and respirational data were recorded at the time of before surgery （T0）,15 minutes after surgery （T1） and 30 minutes after surgery （T2）.The time interval from cease of sevoflurane inhalation to the laryngeal mask removal and adverse events during and after surgery were also recorded.Results A total of 42 patients were enrolled in the study,with 10 cases in group A,17 cases in group B and 15 cases in group C.The hemodynamics of all patients in three groups were stable.There was no significant difference in removal time interval among groups （all P 〉 0.05）.No significant difference was found in end-tidal concentrations of sevoflurane,minute ventilation,pressure of end-tidal carbon dioxide,lung compliance among three time points （all P 〉 0.05）.The respiration rate （per minute） of group B and group C were （33.1 ± 5.7） and （29.4 ± 6.4） at T1,（35.8 ± 7.4） and （32.1 ± 5.6） at T0,respectively,with statistical difference （F =5.087,5.628;P 〈 0.05） at both time points between groups.The peak airway pressure （cmH2O） of group B and group C were （14.5 ±3.1） and （14.3 ±2.2） at T1,（14.1 ± 2.9） and （13.1 ± 1.5） at T0,respectively,with statistical difference （F =4.923,12.393;P 〈 0.05） at both time points between groups.There was no significant difference in end-tidal concentrations of sevoflurane,pressure of end-tidal carbon dioxide,expiratory tidal volume per kg,minute ventilation per kg,respiration rate and peak airway pressure among groups（all P 〉0.05）.There was no severe adverse events during and after surgery in any group.Conclusion The application of PSV during laryngeal mask airway general anesthesia with spontaneous breathing maintained can be a choice for infants and premature patients undergoing ophthalmologic surgeries.